Correlation between Surface Area Ratio of Medial to Lateral Tibial Plateau and Knee Alignment in Adults

Abstract

Objective

This study aimed to investigate the correlation between the surface area ratio of medial tibial plateau (MTP) to lateral tibial plateau (LTP) and the mechanical tibiofemoral angle (mTFA).

Methods

Lower limb computed tomography (CT) images were collected at our hospital. Then, the original CT data were analyzed and reconstructed using medical image processing software. The proximal and distal centres of the femur and tibia were marked. The surface areas of MTP and LTP were identified using image processing software. GraphPad Prism 8.0.2 was used to perform the statistical analysis.

Results

The surface area ratio of MTP to LTP was significantly correlated with the mTFA in all patients (P<0.0001), male group (P<0.0001), female group (P<0.0001), varus group (P<0.0001), and valgus group (P=0.002). Furthermore, the surface area of MTP and LTP was significantly greater in the male group than in the female group (P<0.0001). There was significant difference in the surface area of the MTP between the varus and valgus groups (P<0.0001). Significant difference was also observed in the surface area ratio of MTP to LTP between the varus and valgus groups (P<0.0001).

Conclusion

The surface area ratio of MTP to LTP was correlated with the mTFA. Within a certain range, the smaller the mTFA, the greater the surface area ratio of MTP to LTP. For patients undergoing total knee arthroplasty, of whom the surface area of the MTP was basically equal to that of the LTP, it is recommended that the osteotomy should be performed in accordance with mechanical alignment standards, and that a symmetrical tibial plateau prosthesis should be used. For patients whose surface area of MTP is significantly greater than that of the LTP, it is recommended that the osteotomy should be performed in accordance with kinematic alignment standards, and that an anatomical tibial plateau prosthesis should be used.

Keywords

knee alignment / medial tibial plateau / lateral tibial plateau / surface area ratio / prosthesis types / total knee arthroplasty

References

[1] FlandryF, HommelG. Normal anatomy and biomechanics of the knee. Sports Med Arthrosc Rev, 2011, 19(2): 82-92

[2] ZhangY, ChenY, QiangM, et al.. Morphometry of the Tibial Plateau at the Surface and Resected Levels. J Arthroplasty, 2017, 32(8): 2563-2567

[3] DongXH, HuangXH, ChenM, et al.. Three-dimensional morphometric differences of resected distal femurs and proximal tibias in osteoarthritic and normal knees. BMC Musculoskelet Disord, 2021, 22(1): 1013

[4] ErkocakOF, KucukdurmazF, SayarS, et al.. Anthropometric measurements of tibial plateau and correlation with the current tibial implants. Knee Surg Sports Traumatol Arthrosc, 2016, 24(9): 2990-2997

[5] Hsu RW, Himeno S, Coventry MB, et al. Normal Axial Alignment of the Lower Extremity and Load-Bearing Distribution at the Knee. Clin Orthop Relat Res, 1990, (255):215–227

[6] MorelandJR, BassettLW, HankerGJ. Radiographic analysis of the axial alignment of the lower extremity. J Bone Joint Surg Am, 1987, 69(5): 745-749

[7] TangWM, ZhuYH, ChiuKY. Axial alignment of the lower extremity in Chinese adults. J Bone Joint Surg Am, 2000, 82(11): 1603-1608

[8] VictorJM, BassensD, BellemansJ, et al.. Constitutional Varus Does Not Affect Joint Line Orientation in the Coronal Plane. Clin Orthop Relat Res, 2014, 472(1): 98-104

[9] MandlLA. Osteoarthritis year in review 2018: clinical. Osteoarthritis Cartilage, 2019, 27(3): 359-364

[10] PriceAJ, AlvandA, TroelsenA, et al.. Knee replacement. Lancet, 2018, 392(10158): 1672-1682

[11] ShanL, ShanB, SuzukiA, et al.. Intermediate and Long-Term Quality of Life After Total Knee Replacement: A Systematic Review and Meta-Analysis. J Bone Joint Surg Am, 2015, 97(2): 156-168

[12] DaiY, ScuderiGR, BischoffJE, et al.. Anatomic tibial component design can increase tibial coverage and rotational alignment accuracy: a comparison of six contemporary designs. Knee Surg Sports Traumatol Arthrosc, 2014, 22(12): 2911-2923

[13] JinC, SongEK, PrakashJ, et al.. How Much Does the Anatomical Tibial Component Improve the Bony Coverage in Total Knee Arthroplasty?. J Arthroplasty, 2017, 32(6): 1829-1833

[14] SchiraldiM, BonzaniniG, ChirilloD, et al.. Mechanical and kinematic alignment in total knee arthroplasty. Ann Transl Med, 2016, 4(7): 130

[15] LeeYS, HowellSM, WonYY, et al.. Kinematic alignment is a possible alternative to mechanical alignment in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2017, 25(11): 3467-3479

[16] RivièreC, IranpourF, AuvinetE, et al.. Alignment options for total knee arthroplasty: A systematic review. Orthop Traumatol Surg Res, 2017, 103(7): 1047-1056

[17] AghaR, Abdall-RazakA, CrossleyE, et al.. The STROCSS 2019 Guideline: Strengthening the Reporting of Cohort Studies in Surgery. Int J Surg, 2019, 72: 156-165

[18] FürmetzJ, SassJ, FerreiraT, et al.. Three-dimensional assessment of lower limb alignment: accuracy and reliability. Knee, 2019, 26(1): 185-193

[19] AsadaS, MoriS, InoueS, et al.. Location of the ankle center for total knee arthroplasty. Knee, 2017, 24(1): 121-127

[20] SikorskiJM. Alignment in total knee replacement. J Bone Joint Surg Br, 2008, 90: 1121-1127

[21] VictorJ, DujardinJ, VandenneuckerH, et al.. Patient-specific guides do not improve accuracy in total knee arthroplasty: a prospective randomized controlled trial. Clin Orthop Relat Res, 2014, 472(1): 263-271

[22] VideJ, FreitasTP, RamosA, et al.. Patient-specific instrumentation in total knee arthroplasty: simpler, faster and more accurate than standard instrumentation—a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc, 2017, 25(8): 2616-2621

[23] MaY, Mizu-UchiH, OkazakiK, et al.. Effects of tibial baseplate shape on rotational alignment in total knee arthroplasty: three-dimensional surgical simulation using osteoarthritis knees. Arch Orthop Trauma Surg, 2018, 138(1): 105-114

[24] BagariaV, BhansaliR, PawarP. 3D printing- creating a blueprint for the future of orthopedics: Current concept review and the road ahead!. J Clin Orthop Trauma, 2018, 9(3): 207-212

[25] HellerM, BauerHK, GoetzeE, et al.. Applications of patient-specific 3D printing in medicine. Int J Comput Dent, 2016, 19(4): 323-339

[26] KönigIR, FuchsO, HansenG, et al.. What is precision medicine?. Eur Respir J, 2017, 50(4): 1700391

[27] CalliessT, BauerK, Stukenborg-ColsmanC, et al.. PSI kinematic versus non-PSI mechanical alignment in total knee arthroplasty: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc, 2017, 25(6): 1743-1748

[28] CourtneyPM, LeeGC. Early Outcomes of Kinematic Alignment in Primary Total Knee Arthroplasty: A Meta-Analysis of the Literature. J Arthroplasty, 2017, 32(6): 2028-2032.e1

[29] LuoZ, ZhouK, PengL, et al.. Similar results with kinematic and mechanical alignment applied in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2020, 28(6): 1720-1735